儿童传染性单核细胞增多症临床特征及治疗的单中心研究

A single center study on the clinical features and treatment of infectious mononucleosis in children

目的探讨儿童传染性单核细胞增多症（infectious mononucleosis，IM）的临床特征，比较一般治疗与抗病毒治疗对于IM的疗效差别。方法前瞻性的研究分析2016年1月1日至12月31日在我院住院诊断为IM患者的临床资料及实验室检测指标，根据人院先后顺序分成一般治疗组和抗病毒组，观察两组在住院后至出院12月内的临床症状体征及实验室指标的变化情况等。结果患者总数为201例，男：女为1．72：1；年龄8月至13岁6月（平均4．8±2．8岁）；夏秋两季发病占64．18％；临床症状体征发生情况为发热（97．51％）、咽峡炎（79．10％）、淋巴结肿大（68．66％）、眼睑浮肿（67．16％）、肝大（53．73％）、脾大（46．77％）等。抗病毒组与一般治疗组比较，在热程、咽峡炎改善时间，淋巴结、肝、脾肿大恢复时间，异型淋巴细胞恢复正常时间，淋巴细胞功能恢复正常时间等方面差异无统计学意义（P〉0．05）。但在短期降低血清／浆或全血EBVDNA上，抗病毒组有显著疗效（P〈0．01），而对于长期降低EBVDNA上，两组差异无统计学意义（P〉0．05）。EBVIgG低亲和力抗体在3个月和6个月后转换为高亲和力的比率为89．41％和98．68％。血清／浆EBVDNA在3个月后完全转阴，而全血EBVDNA在12月后阳性率仍有71．11％。结论在一般IM患者的临床治疗上，抗病毒治疗与一般治疗无显著差别，不推荐常规使用抗病毒治疗。IM患者全血中EBVDNA会持续阳性6—12个月以上，故IM患者的病情监测不宜采用全血标本检测EBVDNA。

Objective To investigate the clinical features of children with infectious mononucleosis （IM） , to compare the difference of therapeutic effects between general treatment to antiviral therapy for IM. Methods This prospective study analyzed the clinical data and laboratory test results of 201 cases with IM in our hospital from January 1, 2016 to December 31, 2016. The follow-up period was 6-12 months. The patients were divided into two groups according to the order of admission. The clinical symptoms and laboratory test results of the two groups were observed after hospitalization. Results Of the total of 201 patients, male to female is 1.72：1 ; Age： 8 months to 13 years 6 months （ average 4.8 ± 2.8 years） , The disease frequently occurred in summer and autumn, accounted for 64.18%. The major clinical manifestations was fever （ 97.51% ）, angina （79.10%）, enlarged of lymph node （ 68.66% ）, eyelid swelling （67. 16% ） , hepatomegaly （53.73%） and splenomegaly （46.77%）. There was no statistical difference in duration of fever, improved angina time, lymph nodes（liver, spleen） enlargement recovery time, heterotypic lymphocytes normalization time, lymphocyte function normalization time. There was significant difference in reducing the serum/plasma or total blood EBV-DNA in the short term between antiviral group and general treatment group （P 〈 0. 01 ）, but for the long-term reduction of EBV-DNA, there was no significant difference （P 〉 0. 05 ）. The low affinity EBV-CA-IgG was converted to high affinity EBV-CA-IgG in 89.41% of patients after 3 months and in 98.68% of patients after 6 months. With the recovery of the disease, the positive rate of EBV-CA-IgM and EBV-EA-IgG decreased. But the positive rate of EBV-NA-IgG increased. Serum/plasma EBV-DNA was completely overcast after 3 months, but after 12 months, the patient＇ s total blood EBV-DNA positive rate was still 71.11%. Conclusions In general IM patients, there was no significant difference between antiviral therapy and general treatment, so antiviral therapy is not generally recommended. EBV DNA in the whole blood of patients with IM will continue to be positive more than 6-12 months, indicating that to observe changes of IM should not use whole blood samples for EBV DNA testing.